Treatment of Stage 4 Trachoma: Trachomatous Trichiasis with Inward-Turning Eyelid Margin
Stage 4 trachoma represents the most advanced and sight-threatening phase of the disease. The defining feature is trachomatous trichiasis, in which repeated scarring causes the eyelid margin to turn inward, bringing the eyelashes into direct contact with the corneal surface.
Clinical situation
Due to multiple scars, the margin of the eyelid — usually the upper lid — turns inwards (entropion). The eyelashes rub against the cornea and cause ulcerations and chronic inflammation, placing the patient at risk of progressive corneal damage and vision loss.
Treatment approach
The definitive management of trachomatous trichiasis is surgical. While awaiting surgery, a palliative corneal-protection measure may be employed in patients where regular follow-up is feasible.
The complete regimen — including surgical criteria, palliative technique, follow-up intervals, and duration — is available in the full structured protocol.
References
- Stage 4: trachomatous trichiasis (TT)
- Due to multiple scars the margin of the eyelid, usually the upper lid, turns inwards (entropion); the eyelashes rub against the cornea and cause ulcerations and chronic inflammation.
- Stage 4: surgical treatment
- While waiting for surgery, if regular patient follow-up is possible, taping eyelashes to the eyelid is a palliative measure that can help protect the cornea.
- The method consists in sticking the ingrowing eyelashes to the external eyelid with a thin strip of sticking-plaster, making sure that the eyelid can open and close perfectly.
- Replace the plaster when it starts to peel off (usually once a week); continue treatment for 3 months.
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